Adult Health IV Exam 2 Revision Exam And 100% Accurate Answers.
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Course
Collaborative Adult Health
Institution
Collaborative Adult Health
The nurse is admitting a patient who has a neck fracture at the C6 level to the intensive care unit. Which assessment findings indicate neurogenic shock?
a. Involuntary and spastic movement
b. Hypotension and warm extremities
c. Hyperactive reflexes below the injury
d. Lack of sensation or move...
Adult Health IV Exam 2 Revision Exam
And 100% Accurate Answers.
The nurse is admitting a patient who has a neck fracture at the C6 level to the intensive care unit. Which
assessment findings indicate neurogenic shock?
a. Involuntary and spastic movement
b. Hypotension and warm extremities
c. Hyperactive reflexes below the injury
d. Lack of sensation or movement below the injury - Answer Hypotension and warm extremities
An older patient with cardiogenic shock is cool and clammy. Hemodynamic monitoring indicates a high
systemic vascular resistance (SVR). Which intervention should the nurse anticipate?
a. Increase the rate for the dopamine infusion.
b. Decrease the rate for the nitroglycerin infusion.
c. Increase the rate for the sodium nitroprusside infusion.
d. Decrease the rate for the 5% dextrose in normal saline (D5/.9 NS) infusion. - Answer Increase the
rate for the sodium nitroprusside infusion.
To evaluate the effectiveness of the pantoprazole (Protonix) ordered for a patient with systemic
inflammatory response syndrome (SIRS), which assessment will the nurse perform?
a. Auscultate bowel sounds.
b. Ask the patient about nausea.
c. Check stools for occult blood.
d. Palpate for abdominal tenderness. - Answer Check stools for occult blood.
Which finding is the best indicator that the fluid resuscitation for a 90-kg patient with hypovolemic shock
has been effective? - Answer Urine output is 65 mL over the past hour.
Which finding is the best indicator that the fluid resuscitation for a patient with hypovolemic shock has
been effective? - Answer Urine output is 60 mL over the last hour.
,Which intervention will the nurse include in the plan of care for a patient who has cardiogenic shock?
a. Check temperature every 2 hours.
b. Monitor breath sounds frequently.
c. Maintain patient in supine position.
d. Assess skin for flushing and itching. - Answer Monitor breath sounds frequently.
A patient with severe renal failure develops elevated BUN and creatinine levels. The nurse plans care for
the patient based on the knowledge that collaborative care of the patient will be directed toward the
goal of
a. preventing hypertension.
b. replacing fluid volume.
c. diluting nephrotoxic substances.
d. maintaining cardiac output. - Answer maintaining cardiac output.
During change-of-shift report, the nurse is told that a patient has been admitted with dehydration and
hypotension after having vomiting and diarrhea for 4 days. Which finding is most important for the nurse
to report to the health care provider?
A. New onset of confusion
B. Heart rate 112 beats/minute
C. Decreased bowel sounds
D. Pale, cool, and dry extremitiesNew onset of confusion - Answer New onset of confusion
Which information about a patient who is receiving vasopressin (Pitressin) to treat septic
shock is most important for the nurse to communicate to the healthcare provider?
a. The patient's heart rate is 108 beats/min.
, b. The patient is complaining of chest pain.
c. The patient's peripheral pulses are weak.
d. The patient's urine output is 15 mL/hr.The patient is complaining of chest pain. - Answer The patient
is complaining of chest pain.
Five-day-old Oscar has undergone a Norwood Sano operation for hypoplastic left heart syndrome. He
returns to the ICU in stable condition with systolic BP of 55-65 mmHg and HR 135-145. Over the course
of the evening, his systolic BP has slowly trended downward and is now 40-45 mmHg. His filling pressure
is 10-12 mmHg and his HR is 150-170, sinus rhythm. Milrinone is at 0.3 mcg/kg/min. Epinephrine is at
0.5 mcg/kg/min. Dopamine is at 6 mcg/kg/min already and the SBP is unchanged. Which of the
following would be appropriate?
A. Add norepinephrine
B. Add vasopressin
C. Decrease milrinone
D. Give volume of 5 ml/kg - Answer Add vasopressin
Which preventive actions by the nurse will help limit the development of systemic inflammatory
response syndrome (SIRS) in patients admitted to the hospital (select all that apply)?
a. Use aseptic technique when caring for invasive lines or devices.
b. Ambulate postoperative patients as soon as possible after surgery.
c. Remove indwelling urinary catheters as soon as possible after surgery.
d. Advocate for parenteral nutrition for patients who cannot take oral feedings.
e. Administer prescribed antibiotics within 1 hour for patients with possible sepsis. - Answer a. Use
aseptic technique when caring for invasive lines or devices.
b. Ambulate postoperative patients as soon as possible after surgery.
c. Remove indwelling urinary catheters as soon as possible after surgery.
e. Administer prescribed antibiotics within 1 hour for patients with possible sepsis.
After reviewing the information shown in the accompanying figure for a patient with pneumonia and
sepsis, which information is most important to report to the health care provider?
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